The present invention relates in general to a method of suturing for use in the training for and performance of certain laparoscopic procedures, and, more specifically, to a suturing method useful for urethrovesical anastomosis.
A prostatectomy is the surgical removal of the prostate gland. During this procedure, a surgical connection known as an anastomosis is performed between the urethra and the bladder neck. Besides this urethrovesical anastomosis, many other surgical procedures also involve making a sutured connection of a tubular structure such as a blood vessel or a portion of the digestive tract.
Laparoscopic techniques are preferentially used in order to achieve improved patient outcomes resulting from minimally invasive procedures. In certain types of endoscopic surgery (e.g., some laparoscopic surgeries), it is customary to form a plurality of incisions in the body surface of the patient, insert trocars (tubular instruments) into the respective incisions as instrument passage ports, and introduce the tip ends of instruments having shafts through the respective trocars and into the body cavity in order to perform a surgical operation on the affected part of the body. Working manipulators (i.e., forceps) such as a gripper for gripping living tissue, scissors, the blade of an electrosurgical knife, etc., may be mounted on the tip ends of the laparoscopic instruments.
Because the working space within the body cavity is small, manipulators passing through the trocars are moved within the cavity using the trocars as fulcrums. Many conventional instruments do not have joints in the working unit on the tip end thereof. Because of the small degree of freedom of movement, the types of endoscopic surgery that can be performed with such instruments are limited to a certain range. Therefore, instruments have been developed having a plurality of joints in a working unit thereof (see, for example, Japanese Laid-Open Patent Publication No. 2002-102248 and U.S. Patent Application Publication 2009/0240263, incorporated herein by reference). Such a manipulator reduces many of the limitations and difficulties posed by conventional forceps instruments.
Manipulators are becoming available with grippers on the tip that articulate with both a yaw motion and a roll motion. The motions may be motor driven. Even with improved manipulators, however, certain laparoscopic procedures remain difficult to perform and train for. A source of difficulty is that the proper placement and motion of the gripper when performing tasks (such as suturing for a urethrovesical anastomosis) involves three-dimensional interpretation and planning on the part of the surgeon who views the surgery via a two-dimensional endoscopic camera. Orientation of the suturing needle, positioning of the joints of the manipulator, and the direction of driving of the various parts of the manipulator all affect whether a successful result is obtained. Therefore, it would be desirable to simplify the procedure for an anastomosis.